86 



SURGERY. 



An incision is made with a scalpel in the direction of the dotted 

 line of the drawing, (fig. 24,) of about three inches in length, commenc- 

 ing about one inch behind the scrotum, an^ extending downwards and 

 outwards to a point between the anus and tuberosity of the ischium, 

 and even beyond it. Various measurements are given by diflerent 

 surgeons as to the point at which this is to be commenced. No well- 

 informed surgeon should depend upon an absolute measurement, on 

 account of the difference which exists in different patients, with re- 

 ference to the size and depth of the perineum. He should inform 

 himself of the probable size of the prostate gland by an examination 

 per anum, and then, by his anatomical knowledge, make his inci- 

 sion so as to expose the membranous portion of the urethra, taking 

 care not to cut the bulb of the corpus spongiosum in front and the 

 rectum behind. Having cut through the skin and superficial fascia 

 of the perineum, which is very thick, especially in fat persons, the 

 transversus perinei muscle, the transversus perinei artery, the lower 

 edge of the triangular ligament, and it may be a few fibres of the 



Fig. 25. 



levator ani muscle, must then be divided. By an examination with the 

 finger, the staff may now be felt in the urethra. By means of the 

 finger and nail this space should be increased, and the urethra 

 opened by a bistoury, which will be indicated by a flow of urine. 

 The gorget should now be introduced into the wound, with its beak 

 securely fixed in the groove ; it is then pushed in the direction of the 

 bladder, cutting through its neck and prostate gland. Care must be 

 taken to depress the handle of the gorget whilst making this thrust, 

 for fear of wounding the rectum. Urine gushes out, the gorget is 

 carefully removed, for fear of wounding the internal pudic artery, 

 and the finger introduced into the bladder to discover the stone, its 



